Attention:
Copy A of this form is provided for informational purposes only. Copy A appears in red,
similar to the official IRS form. The official printed version of Copy A of this IRS form is
scannable, but the online version of it, printed from this website, is not. Do not print and file
copy A downloaded from this website; a penalty may be imposed for filing with the IRS
information return forms that can’t be scanned. See part O in the current General
Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more
information about penalties.
Please note that Copy B and other copies of this form, which appear in black, may be
downloaded and printed and used to satisfy the requirement to provide the information to
the recipient.
To order official IRS information returns, which include a scannable Copy A for filing with
the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms. Click on
Employer and Information Returns, and we’ll mail you the forms you request and their
instructions, as well as any publications you may order.
Information returns may also be filed electronically using the IRS Filing Information Returns
Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act
Information Returns (AIR) program (visit www.IRS.gov/AIR).
See IRS Publications 1141, 1167, and 1179 for more information about printing these tax
forms.
VOID
9595
CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
1 Rents
OMB No. 1545-0115
2016
$
2 Royalties
PAYER’S federal identification number RECIPIENT’S identification number
Miscellaneous
Income
$
Form 1099-MISC
3 Other income
4 Federal income tax withheld
$
$
5 Fishing boat proceeds
6 Medical and health care payments
$
$
RECIPIENT’S name
7 Nonemployee compensation
8 Substitute payments in lieu of
dividends or interest
Street address (including apt. no.)
$
$
City or town, state or province, country, and ZIP or foreign postal code
9 Payer made direct sales of
10 Crop insurance proceeds
$5,000 or more of consumer
products to a buyer
$
(recipient) for resale ▶
11
FATCA filing 2nd TIN not. 13 Excess golden parachute
requirement
payments
Account number (see instructions)
$
15a Section 409A deferrals
$
Form 1099-MISC
15b Section 409A income
$
Cat. No. 14425J
16 State tax withheld
$
$
www.irs.gov/form1099misc
12
Copy A
For
Internal Revenue
Service Center
File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2016 General
Instructions for
Certain
Information
Returns.
14 Gross proceeds paid to an
attorney
$
17 State/Payer’s state no.
18 State income
$
$
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
VOID
CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
1 Rents
OMB No. 1545-0115
2016
$
2 Royalties
PAYER’S federal identification number RECIPIENT’S identification number
Miscellaneous
Income
$
Form 1099-MISC
3 Other income
4 Federal income tax withheld
$
$
5 Fishing boat proceeds
6 Medical and health care payments
$
$
RECIPIENT’S name
7 Nonemployee compensation
8 Substitute payments in lieu of
dividends or interest
Street address (including apt. no.)
$
$
City or town, state or province, country, and ZIP or foreign postal code
9 Payer made direct sales of
10 Crop insurance proceeds
$5,000 or more of consumer
products to a buyer
$
(recipient) for resale ▶
Account number (see instructions)
FATCA filing
requirement
11
12
13 Excess golden parachute
payments
14 Gross proceeds paid to an
attorney
$
15a Section 409A deferrals
$
Form 1099-MISC
15b Section 409A income
$
16 State tax withheld
$
$
www.irs.gov/form1099misc
Copy 1
For State Tax
Department
$
17 State/Payer’s state no.
18 State income
$
$
Department of the Treasury - Internal Revenue Service
CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
1 Rents
OMB No. 1545-0115
2016
$
2 Royalties
PAYER’S federal identification number RECIPIENT’S identification number
Miscellaneous
Income
$
Form 1099-MISC
3 Other income
4 Federal income tax withheld
$
$
5 Fishing boat proceeds
6 Medical and health care payments
$
$
RECIPIENT’S name
7 Nonemployee compensation
8 Substitute payments in lieu of
dividends or interest
Street address (including apt. no.)
$
$
City or town, state or province, country, and ZIP or foreign postal code
9 Payer made direct sales of
10 Crop insurance proceeds
$5,000 or more of consumer
products to a buyer
$
(recipient) for resale ▶
Account number (see instructions)
FATCA filing
requirement
11
12
13 Excess golden parachute
payments
14 Gross proceeds paid to an
attorney
$
15a Section 409A deferrals
$
Form 1099-MISC
15b Section 409A income
$
(keep for your records)
16 State tax withheld
$
$
www.irs.gov/form1099misc
$
17 State/Payer’s state no.
Copy B
For Recipient
This is important tax
information and is
being furnished to
the Internal Revenue
Service. If you are
required to file a
return, a negligence
penalty or other
sanction may be
imposed on you if
this income is
taxable and the IRS
determines that it
has not been
reported.
18 State income
$
$
Department of the Treasury - Internal Revenue Service
CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
1 Rents
OMB No. 1545-0115
2016
$
2 Royalties
PAYER’S federal identification number RECIPIENT’S identification number
Miscellaneous
Income
$
Form 1099-MISC
3 Other income
4 Federal income tax withheld
$
$
5 Fishing boat proceeds
6 Medical and health care payments
$
$
RECIPIENT’S name
7 Nonemployee compensation
8 Substitute payments in lieu of
dividends or interest
Street address (including apt. no.)
$
$
City or town, state or province, country, and ZIP or foreign postal code
9 Payer made direct sales of
10 Crop insurance proceeds
$5,000 or more of consumer
products to a buyer
$
(recipient) for resale ▶
FATCA filing
requirement
Account number (see instructions)
11
12
13 Excess golden parachute
payments
14 Gross proceeds paid to an
attorney
$
15a Section 409A deferrals
$
Form 1099-MISC
15b Section 409A income
$
16 State tax withheld
$
$
www.irs.gov/form1099misc
Copy 2
To be filed with
recipient's state
income tax return,
when required.
$
17 State/Payer’s state no.
18 State income
$
$
Department of the Treasury - Internal Revenue Service
VOID
CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
1 Rents
OMB No. 1545-0115
2016
$
2 Royalties
PAYER’S federal identification number RECIPIENT’S identification number
Miscellaneous
Income
$
Form 1099-MISC
3 Other income
4 Federal income tax withheld
$
$
5 Fishing boat proceeds
6 Medical and health care payments
$
$
RECIPIENT’S name
7 Nonemployee compensation
8 Substitute payments in lieu of
dividends or interest
Street address (including apt. no.)
$
$
City or town, state or province, country, and ZIP or foreign postal code
9 Payer made direct sales of
10 Crop insurance proceeds
$5,000 or more of consumer
products to a buyer
$
(recipient) for resale ▶
11
FATCA filing 2nd TIN not. 13 Excess golden parachute
requirement
payments
Account number (see instructions)
$
15a Section 409A deferrals
$
Form 1099-MISC
15b Section 409A income
$
16 State tax withheld
$
$
www.irs.gov/form1099misc
12
Copy C
For Payer
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2016 General
Instructions for
Certain
Information
Returns.
14 Gross proceeds paid to an
attorney
$
17 State/Payer’s state no.
18 State income
$
$
Department of the Treasury - Internal Revenue Service